Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Clin Gastroenterol Hepatol. 2015 May;13(5):949-55. doi: 10.1016/j.cgh.2014.09.042. Epub 2014 Oct 2.
BACKGROUND & AIMS: Cytomegalovirus (CMV) is an opportunistic pathogen; documented tissue involvement of patients with inflammatory bowel disease (IBD) is associated with adverse outcomes. We quantified the density of CMV inclusions in biopsy specimens from patients with IBD and assessed their response to antiviral therapy.
In a case-control study, we identified all small bowel and colon biopsy specimens collected from 1111 patients with IBD that had been submitted to the Department of Laboratory Medicine and Pathology, Mayo Clinic, to evaluate for CMV in intestinal tissue from 2005 through 2011. All positive cases were reviewed to confirm the diagnosis of CMV in tissue. We determined the number of viral inclusions in each processed biopsy sample. Biopsy specimens with 5 or more inclusions were considered to have high-grade CMV density. We collected data on response to antiviral therapy and history of surgical resection within 1 year after diagnosis of CMV in tissue. CMV-negative samples (controls) were selected from the same IBD population. Primary outcomes included clinical improvement, hospital admission, time to admission, need for surgical procedures, time to surgery, escalation of therapy, and relapse of CMV infection.
In our analysis of the biopsy samples, 68 (6%) were found to contain CMV. Follow-up data and treatment outcomes were available from 50 cases, including 16 patients with high-grade CMV density (all treated) and 34 with low-grade CMV density (20 treated). There was no overall difference in survival, free of surgery, between patients with or without CMV 1 year after diagnosis in tissue. Antiviral treatment improved surgery-free survival outcomes of patients with CMV infection—particularly of patients with high-grade CMV density.
Patients with IBD and a high density of CMV inclusions in intestinal biopsy specimens benefit from antiviral therapy. Patients with fewer viral inclusions in biopsy specimens also might benefit, but the severity of the IBD should be the prime consideration in determining treatment strategies.
巨细胞病毒（CMV）是一种机会性病原体；有文献记载，炎症性肠病（IBD）患者的组织受累与不良结局相关。我们定量评估了 IBD 患者活检组织中 CMV 包涵体的密度，并评估了它们对抗病毒治疗的反应。
在一项病例对照研究中，我们从 2005 年至 2011 年期间，从梅奥诊所检验科收集的 1111 例 IBD 患者的小肠和结肠活检标本中，确定了所有用于评估肠道组织中 CMV 的标本。对所有阳性病例进行了回顾性分析，以确认组织中 CMV 的诊断。我们确定了每个处理过的活检样本中的病毒包涵体数量。包涵体数量达到或超过 5 个的活检标本被认为具有高等级 CMV 密度。我们收集了组织中诊断 CMV 后 1 年内抗病毒治疗反应和手术切除史的数据。CMV 阴性样本（对照组）从同一 IBD 人群中选择。主要结局包括临床改善、住院、住院时间、手术需要、手术时间、治疗升级和 CMV 感染复发。
在对活检样本的分析中，发现 68 例（6%）样本中含有 CMV。我们获得了 50 例病例的随访数据和治疗结果，包括 16 例高等级 CMV 密度患者（均接受治疗）和 34 例低等级 CMV 密度患者（20 例接受治疗）。在组织中诊断 CMV 1 年后，无论患者是否有 CMV，其生存率和免于手术率没有差异。抗病毒治疗改善了 CMV 感染患者的无手术生存率，尤其是高等级 CMV 密度患者。
患有 IBD 且肠道活检标本中 CMV 包涵体密度较高的患者受益于抗病毒治疗。活检标本中病毒包涵体较少的患者也可能受益，但在确定治疗策略时，应主要考虑 IBD 的严重程度。
